Changing world of ObGyn training

Has the world changed and left me behind, or was it always so, and I never realized because I never looked at it properly? The current generation of residents and students have put me in a confused state over this issue. I was quite upset that in spite of my repeated explanation that the standard practice of putting a uterine sound into the uterine cavity was a safety precaution for preventing uterine or cervical perforation, my resident doctors just would not do so. It reached such a stage that the theater-nurses stopped keeping a uterine sound on the instruments' trolley, The residents ware changing our science! Finally I had had enough and decided to conduct an on the spot test to check their awareness level of this issue. Two of my senior residents (third year) had just performed first trimester pregnancy terminations without using a sound to check the direction of the cervical canal prior to cervical dilatation. I called all residents, gave each of them a piece of paper and asked them to write the need for a uterine sound while performing a first trimester pregnancy termination. Two of them wrote “neo need”. All others, including two fourth year residents (qualified to be consultants) gave wrong answers except one second year resident. Some of them measured utero-cervical length, which was inviting fundal perforation, since the gravid uterus is quite soft. Some of them measured the length of the cervical canal. One first year resident had been present when I had told the correct answer to one of the two erring third year residents. Even he gave a wrong answer. I gave him minus ten marks; minus five for giving a wrong answer, and minus five for inability to comprehend spoken English. I told the resident who had given the correct answer that I was quite happy with her, and she beamed. Then she washed up for the next case with me, and put a uterine manipulator into the uterine cavity without sounding it first. So I had a theory-master who would not practice what she knew was right. I have no clue why they behave in this way. I don't think they think they are more knowledgeable than me, because I keep asking them questions, and tell them the right answers when they cannot answer. I don't think they want to revolt against discipline, because they are otherwise quite decent people. I think it is their training, and someone else has been a more effective trainer than me, though unfortunately a wrong one. Habits don't die hard, habits don't ever die, period. To top this all, my undergraduate students entered the operation theater at that unfortunate moment. I gave them the test too. Out of four of them, one borrowed a pen from my first year resident. I laughed at this, As soon as I had finished my residents about this, another student asked me to lend her my pen. I was aghast. As students we never even thought of asking the Boss to lend us his pen or anything else. And none of the students answered the question correctly. My third third-year, resident said he knew the right answer and practiced it so, but did not take the test because he had heard the answer from me when I corrected the erring resident. He turned out to have taught the students this topic. To confirm that he had taught them the right thing, I asked the students to show me the notes they had taken that time. They just stood there hanging their heads. They had not taken any notes! I think the world has indeed changed, and probably for worse.

Steal a Professor

It began in a way that was quite subtle, and unexpected. We had two vacancies of Professors in our department, We had one eligible person for this post, The other one was at another corporation hospital in the city, Both posts had been vacant for about 2 years. Finally our own candidate pushed them so much that the promoted both of them. Our candidate joined immediately. The other one would not. She wanted to get promoted where she was, without there being a vacancy in her institute. She was said to be quite influential, she had received her previous promotion while she had been on long leave, out of the country. Such things don't happen unless you are well connected, This time she came to see me and requested me to a allow her to remain at her own hospital for one year, so that she could finish her projects, I said 'No', because we were really short-staffed and overworked. She had put up a letter to this effect, on which I had written in detail Why Such a thing was not possible, Then we heard that she was trying to get our post transferred to her hospital. I told the Dean about this in a meeting of all heads of departments, The Dean said, 'That will not happen', which should have reassured me. It didn't, A short while later, the Dean told me in another meeting of all heads of departments that since she (the said candidate) had met a number of people (read high up people), we would allow her to remain where she was until end of June, and she would join duty with us on 1st of July. We had sent letters to the Commissioner against this arrangement, which had probably made the Dean stall the issue till end of June. I knew why she set that particular date. The Dean was to retire from 1st july. And would not be there to answer any questions if this person did not come as stated. She was said to be related to the VC and the Dean both. Which explained a lot of things that happened. First July came, but the Professor did not come, The Dean was not there to give any explanation, about this, very conveniently. We wrote a number of letters to higher authorities including the commissioner. There was no response, Then this person met an AMC, who just sent an order allowing her to become a professor of our institute, take salary from us, and work in her hospital, not ours. We protested strongly, but they all ignored us. She was given this post, because the order came from a higher officer, an AMC, higher than our new Dean. The interest of a healthcare giant and its poor patients was put aside for an individual, whose only virtue was being well-connected. It was not just injustice of the highest order, it was corruption of the system and dictatorship of a sort in a country with the greatest democracy in the world. We hear that our erstwhile Dean, now merrily appointed to a higher position owing to her own connections, had actually arranged all this. She as a Dean was expected to safeguard the interest of the institute, She not only failed to perform this duty, but actually caused irreparable damage to the institute. When this happened and we were feeling lost, with no solution in sight, one of our Associate Professors said, "May be she will just die". I was somewhat taken aback, but it seemed it would be the only solution if God also wished it. God did not. She lives; shamelessly. In the corrupt world of the corporation, the medical colleges and hospitals were spared somewhat so far. Not any more. If God is watching all this, I hope He corrects the wrongs, because I know there is no one in corporation who has integrity enough to set wrongs right.

Medical Dementors

Careless dementors: It takes a great deal of effort to mentor someone, Unfortunately in the current residency system, the mentee does not remain with the mentor until the process is complete. The residents are rotated from one unit to another, with the objective of exposing them to different consultants. They are expected to pick up the best from each of consultants. Unfortunately, bad habits are picked up far more readily than the good ones. When I spend six months (the duration of one post) training a batch of residents, I expect them to remember what I teach them, and practice that at least until they find something better. Unfortunately, if they go to some other consultants in the next couple of posts, and then return to me, I sometimes find them adopting some clinical practices that are not found anywhere in the medical books and journals, that do not stand to logical scrutiny that should be a part of every clinician’s practice. There is no explanation of this phenomenon other than that they unlearnt whatever I taught them, and learnt something different while they were away from me. It is unlikely, but not impossible, that the consultants they worked with forced them into doing this. I feel it is unlikely because someone so senior would not openly advise something against standard teachings. I feel it is not impossible, because there are some people who believe that what they feel about any clinical situation at a given moment is the final truth, and then things like evidence-based practice become superfluous, But I feel that a more likely explanation is that such consultants often indulge in practices that deviate from standard practices without realizing the implications. When the residents see such things happen, or are themselves a part of those happenings, they come to believe after some time that those are the norms or standard practices. The seniors who indulge in deviations from standard management guidelines sometimes cause harm to their patients, but many patients get well and never realize that not-so-correct treatment was given to them. But a greater damage is done by these senior clinicians to the residents, who pick up wrong practices, and even teach those to their juniors. Some of the residents are intelligent, and understand the errors of their ways when they read books and journals. But many others do not apply their minds to this and continue with such practices. These seniors who undo the work of good teachers and mentors are, in my opinion, dementors. The dementors are either the victims of senior dementors, or have become so all by themselves. The sad thing is that it is beyond anyone's control to correct either the victims or the dementors. The good thing is that God watches over the patients and generally nothing much goes wrong. But when things go wrong, there is grief for those affected, and even if they go to court and get justice, the damage done cannot be reversed.